By Rachel Factor LCSW
An individual with health anxiety wants to know for certain that he is not suffering from illness. He may frequently visit doctors to get reassurance that everything is okay with his health. However this provides at most temporary relief until the doubts begin to return. “Did the doctor understand me correctly?” Or, “Did I forget any details?”
Some people with health anxiety scan the Internet to check up on any symptoms of illness. Others will ask friends and family for reassurance. Their loved ones may say, “Stop looking for things to worry about. You’ll just make yourself sick from worry.” If only it was so easy to stop.
It is estimated that between 4 – 6% of the population struggles with health anxiety. Indeed up to 10% of all visits to primary care physicians are related to health anxiety (OCD center of LA). Studies do not indicate that people with health anxiety actually live longer. Their frequent self-checking, reassurance seeking, trips to the doctor, and repeated medical tests are likely in vain. This is not to say that there haven’t been stories of individuals obsessing about health and eventually making a discovery of illness. However, stories like this are few and far between. All the anxiety and scrupulous attempts at staying healthy do come at a price. Someone who is preoccupied by thoughts of illness is missing out on the life he has. As one person summed it up, “If nothing really is wrong, look at the time I’ve wasted and lost. And if something is wrong, look at the time I’ve wasted, lost, and will never have a chance to recover.” (Grayson, 2014)
With health anxiety, as well as other forms of anxiety, the therapeutic work is not in convincing the client that his fear won’t materialize; rather the goal is to learn to live with uncertainty. None of us have any guarantees about our health. The difference for the individual with anxiety is that he is acutely aware of it at all times and nonetheless must learn to accept the lack of certainty.
When fearful thoughts arise, I teach my clients to learn to notice their thoughts, without acting upon them. I tell them to imagine that they are standing at a train station. The trains are passing through. Imagine the trains as our thoughts. We can watch the trains come and go, but we don’t have to get on them. With practice, one can learn to let thoughts pass and react less to them.
The therapist and the client can create guidelines, and at times consult with the doctor as well, regarding how to relate to their health symptoms. For example, I discourage clients from seeking reassurance for questions that were previously asked and tell them to limit or cut out spending time online researching their feared illness. The guidelines will be individualized to how the client experience his anxiety.
The therapist, together with the client, can create scripts that will expose the client to his feared consequence. Exposure scripts help a person habituate to their fears. The more someone exposes himself to his fear, the fear level will correspondingly decrease. The individual needs to repeatedly expose himself to the fear, while not giving in to the impulse to act upon it. He will start with lesser fears and work his way up to greater ones.
When a person has a fear, he feels that if his fear would materialize he couldn’t go on living. I discuss with my clients that if their fear would materialize, although they may be caught off guard initially, hopefully they would find a way to cope. Their life will then become different than the one they had planned on. Maybe they will grow in ways they never even imagined. One never knows how he will respond, but if we begin thinking along these lines we increase the chances in our favor.
A most touching experience was working with Yitzchak. He lived in constant fear of having a life threatening illness. Over time Yitzchak internalized the concept of living with uncertainty. A few years following the conclusion of therapy, Yitzchak called me up and said that his doctor is concerned that he may be suffering from a serious condition. The doctor asked why he hadn’t come sooner to discuss his symptoms. (Based on our guidelines Yitzchak actually should have gone sooner, but chose not to.) I’ll never forget what Yitzchak said to me. “Perhaps I should have gone sooner, but that’s okay. These past few years I learned to live in the moment, enjoy my life, enjoy my family and any price I have to pay for that is worth it.” As an after note, medical tests showed that Yitzchak was indeed fine, but his message still rings clear.